Organization
PENINSULA ORTHODONTICS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VICKI ROSS DMD (PRESIDENT)
(757) 249-4203
Entity
Organization
Contact information
Practice address
401 OYSTER POINT RD, SUITE D, NEWPORT NEWS, VA 23602-6926
(757) 249-4203
(757) 249-4208
Mailing address
401 OYSTER POINT RD, SUITE D, NEWPORT NEWS, VA 23602-6926
(757) 249-4203
(757) 249-4208
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
7301
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA
NA
—
Enumeration date
03/31/2011
Last updated
03/31/2011
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